YUSUF DIAZ
Subscriber on policy B07M000173
Claims
1
Attributed to this person
Charged
519.00
Total submitted
Denied
519.00
1 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | YUSUF DIAZ |
| Role on the policy | Subscriber |
| Policy | B07M000173 |
| Date of birth | 31 Mar 1999 |
| Plan | PLATINUM PPO |
| Covered from | 24 Jun 2024 |
| Covered to | 23 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000697 | 9 Nov 2024 | 519.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 519.00 |